It was as a standing-room only crowd at the health care meeting last week, when Neighborcare Health officials shared information about the clinic and its deficit, and many islanders raised concerns about both phone and in-person access to care.
The Vashon-Maury Island Health Cooperative convened the meeting to help islanders understand the current state of health care on Vashon and be part of a meeting series intended for islanders to also consider what health services they want and how they will pay for them. Those meetings will take place later this month. Earlier this summer, Neighborcare CEO Michael Erikson shared that the Vashon clinic was projected to lose $350,000 this year and that he believes it will need community support to be sustainable over the long term. At the meeting, Neighborcare Chief Operating Officer Meredith Vaughan and Chief Development Officer Joseph Sparacio addressed that issue and others, but stressed Neighborcare’s commitment to Vashon.
“We are not leaving this island,” Vaughan told the approximately 80 people in attendance.
Sparacio led off the evening explaining a bit about federally qualified health centers — which Neighborcare Health is — to help people understand the financial picture at the Vashon clinic. For such clinics, Medicaid payments are higher than for private clinics and hospitals, and the health centers receive grants to support care for the uninsured. Medicaid is the only form of payment that meets or exceeds cost of a visit, he said. Medicare pays only 65 percent, and private or commercial coverage pays 57 percent.
“This is really a flip flop of what you would see for most private practice physicians or hospitals, where folks on Medicaid are people they do not want to see because for them it is the worst payer by far, but for us it creates the most solvency,” he said.
Across the Neighborcare system, the patient mix is 65 percent Medicaid, 7 percent Medicare, 16 percent commercial insurance and 12 percent uninsured
For Vashon, though, the numbers are quite different. At the Sunrise Ridge clinic, Neighborcare providers see about 1,100 patients each month, and the mix is 17 percent Medicaid, 32 percent Medicare, 44 percent commercial insurance, and 7 percent uninsured.
“As you can see, that is not a mix that creates a lot of solvency for us,” he said.
Additionally, he said that Neighborcare receives grant money, mostly from the federal government and City of Seattle, but has restrictions on it, requiring it to be used for low income and uninsured people, for example — and little of it can be used on Vashon, further contributing to the financial gap on the island.
In fact, he said that no clinic in the Neighborcare system could meet the break-even requirement without grant money.
In the last few months, he said, Neighborcare has been working to align its cost of care with revenue, including making staffing changes, looking for additional grants and working with the communities, such as the meeting on Vashon.
Following Sparacio’s presentation, Tim Johnson, who moderated the evening, opened the meeting up to questions for Vaughan and Sparacio, but asked a few himself. One of the first was about the call center, which many islanders have expressed frustration about in recent months, citing long hold times and unreturned messages.
Vaughan fielded the question.
“The centralized call center, I suspect that will be the most popular question this evening,” she said.
She acknowledged difficulties with the system.
“We are taking this very seriously, and we do know that as organization that has to change,” she told those gathered.
She said that most health organizations have a central call center — and that Neighborcare is three to five years behind in developing one. When they are functioning well, she said, they reduce costs and provide better service to patients. Typically, she added, it takes 12 to 18 months to get a center up and running well — and Neighborcare is in month six.
“We are not where we want to be, and our goal is to get there as quickly as possible,” she said.
She added that it is not OK to be on hold, at the longest, for more than three to four minutes.
“We are determined to make it work, and I hear your frustration. It is more than justified, and it needs to get better,” she added.
Vaughan also addressed the long times many patients have reported before they can come in for an appointment when they need one.
Currently, the clinic is two providers short — and only has two providers working.
“Right now things are especially bad,” she said.
As a federally qualified health center, its staffing model is about 50-50 medical doctors and advanced registered nurse practitioners or physician assistants. Earlier this year, Neighborcare eliminated two doctors, and is now recruiting for new staff, with one person slated to start in October.
Overall, the target for providing care to patients is within three days of them seeking care, Vaughan said. That goal is hard for community health centers to meet, she said, and Neighborcare’s target is five to seven days. But islanders have been faced with substantially longer delays than that.
“We have a ways to go to get there because we are not fully staffed and because of the needs of the community, which are different,” she said.
Questions from community members followed, some expressing appreciation for the care they had received, and many others expressing frustration about the barriers to clinic access they have experienced when they or family members needed care, including the lack of available appointments and the phone service. A number of nurses and other health providers from the community also expressed frustration about their own access to the clinic, unable to get through the phone system to clinic staff to obtain needed information. Those who attended also had a chance to speak privately at the end of the meeting with Neighborcare officials regarding any specific problems they wanted to discuss.
At the end of the evening John Jenkel addressed the group. He is a director of the Vashon-Maury Health Collaborative and sits on the Neighborcare board. He likened Neighborcare coming two years ago to throwing a life raft to the island when CHI Franciscan left.
“As we said back then, that is not the end of the story, you have to develop a model that is sustainable,” he said.
To that end, there will be two meetings coming up, exploring what health services islanders would like and then how to pay for them. There are not many models for success, Jenkel said, but funding options range from bake sales at one end of the spectrum to a hospital district at the other.
The next meeting, focusing on health services islanders would like on the island, will be 7 to 9 p.m. Wednesday, Sept. 19, at the Land Trust Building.